S2303: phase II/III trial of paclitaxel + ramucirumab ± nivolumab in gastric and esophageal adenocarcinoma (PARAMUNE).
Anwaar Saeed, Sarah Colby, Paul Eliezer Oberstein...
https://pubmed.ncbi.nlm.nih.gov/40155326/Actively Recruiting
Led by National Cancer Institute (NCI) · Updated on 2026-08-10
224
Participants Needed
374
Research Sites
N/A
Total Duration
Researchers are evaluating the addition of nivolumab to the usual treatment of paclitaxel and ramucirumab compared to paclitaxel and ramucirumab alone in patients with advanced stomach or esophageal adenocarcinoma. This phase IIIII trial aims to see if nivolumab improves progression-free survival and overall survival in these patients. Nivolumab is an immunotherapy monoclonal antibody that may help the immune system attack cancer, while ramucirumab may prevent tumor blood vessel growth, and paclitaxel stops cancer cells from dividing. Participants are randomly assigned to one of two groups. One group receives nivolumab intravenously on day 1 of each 28-day cycle, combined with ramucirumab on days 1 and 15, and paclitaxel on days 1, 8, and 15. The other group receives only ramucirumab and paclitaxel on the same schedule without nivolumab. Treatment cycles continue unless the disease worsens or side effects become unacceptable. During the study, patients undergo CT scans and MRI imaging, and may optionally provide blood samples. Throughout the trial, participants are monitored with regular imaging and optional blood tests. After treatment ends, patients have follow-up visits at 30, 60, and 90 days, then every six months for up to three years. Researchers assess progression-free survival, overall survival, response rates, disease control, safety, and quality of life using questionnaires and patient-reported symptoms. This comprehensive monitoring helps evaluate treatment effects and patient well-being over time.
CONDITIONS
Adding Nivolumab to Usual Treatment for People With Advanced Stomach or Esophageal Cancer, PARAMUNE Trial
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National Cancer Institute (NCI)
Lead Sponsor
This table compares participation in this trial with other options available for this condition. The information is drawn from published research and the trial’s study details and is provided for educational purposes only.
| Factors | Nivolumab + Ramucirumab + Paclitaxel | Ramucirumab + Paclitaxel |
|---|---|---|
| What it is | Combination of nivolumab (immune checkpoint inhibitor), ramucirumab (VEGFR2 antibody), and paclitaxel (chemotherapy), given together as intravenous infusions. | Combination of ramucirumab (VEGFR2 antibody) and paclitaxel (chemotherapy), given together as intravenous infusions. |
| Role in PARAMUNE trial | Tested as an investigational second-line regimen to assess if adding nivolumab improves outcomes compared to standard care. | Serves as the current-care comparator, reflecting established second-line practice for this patient group. |
| Primary use in this setting | Being tested for potential to improve survival and disease control after progression on frontline chemotherapy plus PD-1/PD-L1 inhibitor. | Established second-line treatment for disease control and prolonging survival after first-line therapy failure. |
| How it is given | All three drugs are administered intravenously on a regular schedule as determined by the study protocol. | Both drugs are given as intravenous infusions according to the control arm dosing schedule. |
| Evidence status (as of 2024) | Under active clinical investigation. Efficacy and safety data for this triple-combination in the second-line setting after PD-1/PD-L1-based therapy are not yet established. | Efficacy for improved survival and disease control as a second-line therapy is supported by randomized trials and international guidelines. |
| Important risks and adverse effects | Potential increased risk of immunotherapy-related and chemotherapy side effects, including but not limited to fatigue, diarrhea, neutropenia, and immune-mediated reactions. Full safety data will become available after results are reported. | Common risks include neutropenia, fatigue, diarrhea, hypertension, bleeding, and infusion reactions, as established by prior studies and clinical experience in this setting. |
| Important limitations | Long-term efficacy, safety, and quality-of-life impact are unknown pending trial completion; results will determine benefit over standard care. | While supported for second-line use, this regimen does not always provide durable responses, and resistance or disease progression can still occur. |
Disclaimer: This comparison is created with the help of artificial intelligence(AI) and may contain errors or missing information. It is not medical advice and does not mean one option is better or safer than another. Clinical trials are still being studied, and joining a trial is your choice. Please consult your healthcare professional before making any decisions.
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Duration - 2 to 4 weeks
Participants are screened for eligibility to participate in the trial.
Duration - Until disease progression or unacceptable side effects
Participants receive study treatments according to their assigned group. One group receives nivolumab plus ramucirumab and paclitaxel; the other group receives ramucirumab and paclitaxel only. Treatments are given in 28-day cycles with intravenous infusions on specific days. Participants undergo regular CT and MRI scans to monitor disease.
Infusions on days 1, 8, and 15 of each 28-day cycle; regular imaging visits
Duration - Up to 3 years
After treatment ends, participants have follow-up visits at 30, 60, 90 days and then every six months for up to three years to monitor health and disease status.
Visits at 30, 60, 90 days, then every 6 months
Study Type
INTERVENTIONAL
Masking
NONE
Allocation
RANDOMIZED
Model
PARALLEL
Primary Purpose
TREATMENT
Number of Arms
2
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Anwaar Saeed, Sarah Colby, Paul Eliezer Oberstein...
https://pubmed.ncbi.nlm.nih.gov/40155326/National Cancer Institute (NCI)
Lead Sponsor